Dissociation

Dissociation

The brain mechanism that allows us to define individual reality to accommodate to unsettling events, while remaining aware of another reality, is called dissociation Dissociation is a part of normal human functioning and occurs under normal circumstances. When you leave the house in the morning, become deeply involved in thinking about your plans for the day and find yourself in the parking lot at work, oblivious to the details of the actual drive to work, you have been in a dissociative, or trance state. A hidden and automatic part of you has taken over the driving function, stopped at the appropriate moments, avoided accidents, and guaranteed that you arrive at your desired destination.

Dissociation is a highly evolved mechanism, allowing us increased efficiency by being able to accomplish two tasks at once. One task is in consciousness, one is happening outside of conscious awareness. But there is still a form of knowing about even what was outside of consciousness, termed a “hidden observer”[1]. Speculation is growing that this dual-self phenomenon may have a structural basis in the existence of two separate cerebral hemispheres that intercommunicate under normal circumstances but that each assimilate information in very different ways [2]. Whatever the brain basis for the differences between the conscious and unconscious aspects of our mind turns out to be, it has become clear that we do not have one unified “self” but instead are “a unity and a multiplicity at once” [3]. It is disconcerting to recognize that we have very different and often contradictory aspects of what we think of as “me,” aspects that often react and behave in ways that make us uncomfortable or ashamed. We like to believe that we are always in charge of ourselves, always in control of what we are doing, saying, thinking, feeling, and remembering. As a result, we try to avoid any recognition that we have a split nature, preferring to believe in the largely nonexistent unity of consciousness [4].

As we grow up, many adults constrict their ability to lose themselves in play. But children move between various aspects of reality quite fluidly. This capacity for dissociation is natural and provides children with the opportunity to rehearse new behaviors through play that can be incorporated later as a useful piece of reality. Children often have imaginary playmates and each playmate represents a dissociated part of themselves that they can utilize as a way of mastering unpleasant feeling states while they learn how to integrate those feelings into a coherent sense of self. The good boy, Tommie, can have an imaginary bad boy, Fred, who manages the child’s hostile feelings towards his parents. With healthy parental responses, the child gradually learns to tolerate both loving and hostile feelings as part of his experience of himself.

Dissociation is a particularly useful mechanism during times of high stress. When we are put in situations of danger, we become hyperaroused. Such high states of arousal can be associated with severe cognitive disorganization. Additionally, these same states of arousal are intimately connected with physiological states of high response as well, such as rapid heart rate and increased blood pressure. Past a certain point such physiological hyperarousal can be associated with death [5]. Long-standing accounts have been recorded of both children and adults being literally “scared to death” [6]. The mind has the capacity to defend against the disorganizing, possibly life-threatening outcome of this emotional arousal - a built-in “safety valve.” That capacity is dissociation.

People dissociate in different ways. Fainting is an extreme form of simply stopping consciousness. But we can also split off memories from consciousness through “amnesia.” We can maintain awareness of what is going on around us but feel no disturbing emotions about it - emotional numbing. We can lose our sense of identity entirely and spontaneously create a new one and begin a new life, a condition known as “fugue.” We can set aside our tortured emotions and thoughts and put the entire conflict into a physical symptom such as blindness or paralysis, a symptom picture known as “conversion disorder.” We can dissociate ourselves from our value systems and our conscience, which may be what allows otherwise relatively normal people to commit unconscionable acts under acute stress.

When stress is severe, prolonged, and/or repeated, dissociation can become a preferential way of dealing with stress, particularly if the stress originates in childhood or captivity. Political prisoners and victims of torture become expert at teaching themselves to get away from reality [7]. When this occurs the person may develop very separate bodies of experience, memory, knowledge, and feeling to deal with different stressful situations. It becomes possible then, for the person who has established this tendency to enter these different states of consciousness automatically whenever the particular need arises. Under circumstances of repeated stress, the defensive capacity of dissociation is highly adaptive. But what happens when the stress is reduced and things return to normal? Do we just return to normal life, unchanged by what has happened? Does this ingenious ability have a down side, a negative aspect?

By separating thoughts from feelings, feelings from memory, or thoughts from memory, the body protects itself from being overwhelmed. The person is then able to think without being overwhelmed by terror or despair. People can get things back to normal if they have "forgotten" the events, or at least have "forgotten" the disturbing emotions of the events. If people remain totally isolated from any stimuli that remind them of the events, they may be able to wall off the traumatic events and push them out of consciousness for a lifetime. However, only rarely does a person experience a severe stress that is so isolated and unique that there are no further associations to the event. This is partly because stressful events generally occur in the context of routine daily life and partly because of the associational nature of our brains, which can form astonishingly complex networks of associations between any idea and image.

Car accidents occur on highways, in vehicles that are unavoidable if someone in the United States is to live a semblance of a normal life. Children are abused in bedrooms and bathrooms and kitchens that are equipped with mass produced furnishings that might be encountered anywhere. The stump of a finger lost in an industrial accident is a constant reminder of all of the circumstances of that accident. In order to keep those events - or parts of those events - out of consciousness the person must expend a great deal of psychic energy, which is then unavailable for full and integrated functioning. So why, then, do we often struggle so hard not to know, not to remember, to remain dissociated? That depends to some extent on the particular stress. Common to all stress however, is its tendency to evoke the same response to danger even if the stress no longer presents a danger but is now only a memory of former events.

Curriculum

A Trauma-Informed Psychoeducational Group Curriculum

S.E.L.F. represents the four nonlinear, key areas of recovery that provide an organizing framework for the complex problems presented by trauma survivors, by families with problems, and by chronically stressed organizations.

Creating Sanctuary: Toward the Evolution of Sane Societies

Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care

SanctuaryWeb.com

SanctuaryWeb.com is your resource to gain insight into The Sanctuary Model. Research and purchase S.E.L.F Curriculums. Browse and read published articles, as well as, purchase books written by Dr. Sandra L. Bloom.

Sandra L. Bloom, M.D.Associate Professor, Health Management and Policy, Dornsife School of Public Health, Drexel University

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